Transcript
Merritt Miller (00:00) should be on here momentarily. Hi.
Cinthya Rios (00:04) Cynthia. It’s great to meet you. I know you met with, I think jess a few months ago from our team over at Ivy, but it’s great to meet you. Great to meet you too.
James Donachie (00:20) I am muted. Hi, everyone. How are you?
Merritt Miller (00:25) Good. We can hear you.
James Donachie (00:26) Okay. Unmuted. Awesome. Hi, Cynthia. How are you?
Cinthya Rios (00:34) I am good. How are you? Good?
James Donachie (00:37) Thank you so much for hopping on a call and for your responsiveness. You’ve been very helpful and that letter was… the headline is exciting and actually provides what we need in like a cleaner format… but we wanted to… kind of spend some time today just chatting with you because we have providers daily and I don’t want to inundate your inbox with all the medallion agents asking for it.
James Donachie (01:12) So I wanted to kind of talk through maybe, is there a way that we can, is there like a bulk? Like we have a list of the providers that we need that letter for? Like, are we able to put multiple providers on a letter or just kind of like talk through that? And then merit and Amy can kind of provide like any context about. I don’t know if it’s helpful for you internally about like why they asked for like an update on that run loss report or how we kind of got there, but I figured they could be on the call just to kind of answer any legacy questions because I started working with Ashley and right… around the Christmas time. So I’m a little bit newer. So the process was already in place but we are, we’re open to improving and willing to help however we can. Yeah.
Cinthya Rios (02:08) No, definitely. I think it would be helpful. I mean, we get credentialing requests and for the most part, we’re able to handle them. Like I mentioned, we send out that letter. Usually, I get them from other healthcare facilities looking to give privileges or follow up on for a new employee. So I do want to understand what the requests are for how they’re used. And then that way maybe… the letter’s not the best way. The lost ones aren’t the best way. So we can develop the best way for Ivy to get what they need completed? Great.
Merritt Miller (02:49) Yeah, I’m happy to take it from here. So really nice to meet you like James and trota. Amy and I are on the operations team at medallion kind of helping to facilitate this credentialing process. Oh, right right there. So what we’re running for Ivy, it’s a delegated credentialing workflow with ncqa compliance. And we are working or sorry, Ivy is working to get authorized with mpdb. So in lieu of that, we’re running claims history verifications to get the sanction information or just any claims that have come up in the past. And so what was happening… was we thought we had correct contact on your side and we were getting sent the run loss report which was meeting our requirement. But after further inspection, we realized I think it was more information than we really needed or wanted to house in our system, which is why we halted that process and are kind of seeking maybe a different avenue or different either redacting it or getting something like the letter you showed. So, yeah, high level, it’s for delegated credentialing. We’re looking for current claims history. If there’s just anything showing on your end. And the letter you provided is actually great. Amy and I are just wanting to make sure we don’t overwhelm that inbox or figure out like what’s the workflow for us to get that letter going forward? Okay?
Cinthya Rios (04:13) Okay. So it wasn’t necessarily that you weren’t getting responses from us. It’s that the information that was being provided wasn’t… was more than what we needed to provide. Okay. So I did talk to our operations team and the team that was handling the request. They cannot modify the loss run. We have to send. The way it’s put into the PDF. What I can do is there’s internal ways to pull like an excel spreadsheet… that may, it just may take a little longer to get that approved for Ivey. You know, if we can do something, make an exception for Ivey, where we are able to handle bulk requests by sending the information that you need like similar to the loss run, but without those columns that you requested to be removed or issuing a letter like a sample like I shared. However because of the incident reports that we received from Ivey, there are quite a few. And technically what we’re supposed to do is take that provider’s name and make sure they’re not, you know, listed in any, or named in any of the incidents or claims. And what I usually request is the state in which that provider worked. So I can cross reference the incidents and claims that we do have on file. So that would add another layer and would require time, I mean, maybe a few days. It depends on the number of providers. So those are possibly two workarounds. How quickly do you need responses on the credentialing, on the requests that are sent in?
Merritt Miller (06:20) The request unfortunately kind of directly correlates to our ability to return a complete credentialing packet to the iv side of the house. So with the previous one, we were getting them same day and so it was really helpful to just kind of attach it in there and move the file forward. I wonder if maybe because of the volume, so we have about 60 that are pending this right now. And then once we kind of work through that backlog, there’s about like 20 to 25 per day that we typically see on our side that we were using the loss run reports for. So I, I’d love to kind of figure out a solution where we could just get a few so we could give iv some credentialing files to take through their committee. If we could do like a few following this letter process and then see if you have a better way to take like bulk requests from us or if that’s okay. And it just takes you a few days. I think we at least on the medallion side just want to be as collaborative as possible. But because we’ve been holding for a little bit, we’d love to get a few files through to the iv team.
Cinthya Rios (07:24) And my only concern is if we’re getting 25 requests a day that letter, it’s gonna, that would be tough to be able to turn those around in a few days. So I think what I would like to do, you know, if for one, for the backlog for the 60, can we just provide what we’ve been providing to clear those? And then, so that I can work with an internal team to get an exception or find a way to modify what we’ve been sending as of now. Like I mentioned, the ops team that issues them, they can’t modify it. I’m not supposed to modify it either, but I’m willing to seek an exception for iv to find a different solution that makes it easy for everyone? Yeah.
Merritt Miller (08:15) I think the tough thing on our side is our compliance team is actually asking us to stop accepting those because it looks like there’s patient information on it which we can’t house on our side. So, is there any possibility we could do a few of those letters for a subset like 20 of them? Something like that? Like we could just get the, because the letter is actually probably our preferred piece of verification evidence. The last one reports were okay. But I think the letter is incredibly clear with what it’s representing. So could, do you think we could do the letter for like a subset while maybe you look at how we could do this at a better scale?
Cinthya Rios (08:53) I think we can do that. And then, I mean, from a credentialing letter perspective, the only times we have to report if a claim has been paid for an individual, if incidents don’t matter or non paid claims, it has to be a paid claim, correct?
Merritt Miller (09:15) Okay. That.
Cinthya Rios (09:16) Makes it easier because we don’t have a lot of those. So that, okay?
Ashley Griffiths (09:23) And I think so Cynthia, I just want to make sure I understand too. So on those loss runs, we’re also getting any kind of incidents, right? They’re not necessarily claims.
Cinthya Rios (09:31) Yes. I mean, it’s correct. They’re not all claims, most of them are not, they’re just incidents for the most part. So, yeah. Yeah. So I think we can start there to help the backlog with some letters. And… I know when I asked about giving me the state for the providers, that was going to be tough. Is there any way we can get it for these 20 providers that we’re going to look at? Okay? Yeah.
Merritt Miller (10:05) We can, we can figure something out. I think we could identify it by the work history and just flash it by Ashley and make sure that’s kind of tracking on her side. So we can get you, the state for those?
Cinthya Rios (10:16) Or, the licensed state would apply, right? They can only work in the state that they’re licensed in. So I think.
Ashley Griffiths (10:23) Merit too, they should be assigned practices in the portal. Okay? So we should be able to see the state there. Okay? Perfect.
Cinthya Rios (10:35) So, merit… do you, does?
James Donachie (10:38) It does it make sense for us to we’ll grab 20 20 of them. We’ll we’ll grab that information. Ashley. Once we have it, I’ll send it to you just quickly to make sure that our states, you can just give it like a once over, and then we can send it once we have, we’ll make sure the states are right? So that you’re not doing extra work. And then, we can send it to, we’ll send that list over to you. And then, Ashley, it sounds like we’ll we can, we’ll work on those? I know, your committee, was it on Friday next week or was it actually on Monday?
Ashley Griffiths (11:19) Monday, the thirtieth,
James Donachie (11:21) oh, okay. So we have a couple extra days, which is great. Then we’ll work on processing those. I was speaking with merit and Amy before, and we think like just giving you guys making sure we have files for that committee meeting will be like a great first step. And then… Cynthia, I guess we’ll wait for me. I know you have to go and there are internal processes just like we dealt with our compliance. I know you have compliance and people to answer to, but yeah, maybe there like is a way to kind of bulk do it. I don’t think it will be like 25. Keep me honest, merit. It’s not like 25 every single day, but it does like fluctuate. And so we just wanted to, we didn’t want to like overwhelm or like really bottleneck your, the process there?
Cinthya Rios (12:14) Yeah. So, is… it 25 a week, 50 a week? I know, like you said, it’s not every day and how long is this going to be? Is this like a project that’s forever or is it like a year? Like what are we looking at? Like how long would this be occurring? We’re.
Ashley Griffiths (12:36) hoping this is only temporary. Yeah. So we’re in the midst of putting together our npdb application. Again, this will be our fourth attempt at applying. We think we have a really strong case this time. So hopefully we get approved. If we get approved by npdb then this manual process goes away because we can just query that database.
Cinthya Rios (13:02) Okay. Interesting. Okay. I didn’t know this was part of the process. Wow, it’s a lot. It’s a lot… yes, yes.
Merritt Miller (13:11) It is, we will certainly keep you updated. Yeah, if there’s npdb approval, we’re throwing a party?
James Donachie (13:16) Yeah, yeah.
Cinthya Rios (13:17) And I,
Ashley Griffiths (13:20) think really once we get through like, gosh, I don’t even want to say this out loud. But if we don’t get approved by npdb once we’re through this like backlog of all of our existing files, right? Merit. And Amy, correct me if I’m wrong, but then it’s just new hires flowing through. And so at that point, it’s a lot smaller number. I think it’s probably that, you know, maybe 15 a week or something like that and I could be off on that, but I’m sure there’s some seasonality splashed in there, but this is really getting us through like our existing provider files, got.
Cinthya Rios (13:55) It. Okay. So we’re essentially credentialing everyone that’s currently on board exactly.
Ashley Griffiths (14:00) Exactly.
Cinthya Rios (14:01) Okay. All right. And then it’ll be for the policy periods. The requests are for the policy periods that navigators have been on the program. Yeah. Okay. All right. Perfect. All right. I think we’ll start there and then I’ll start the internal discussions… given that again that… we don’t have a lot of paid claims, this might not be as bad as I thought we can pinpoint the claims we’ve actually paid and identify if there were any providers individually named, and we’ll track it that way. Amazing. Yeah, I think that should be easy enough. I’ll just run it by the team and make sure everyone’s on board. And hopefully that solves for this.
Merritt Miller (15:01) Great. We really appreciate it. Cynthia. No, thank.
Cinthya Rios (15:04) You all. Sorry about this? Yes. No, thank you for helping me understand the process and what we need to do. So, yeah, we’ll get started with that if you want to send me those names with the authorization letters. We’ll move forward on getting those done as quickly as possible.
Ashley Griffiths (15:24) Thank you, Cynthia. Thank.
Cinthya Rios (15:25) you.
James Donachie (15:26) Yeah, thank you so much. All right. Bye everyone.
Cinthya Rios (15:30) Bye. Have a good one. Bye.